Health Tutorials Break Down Barriers

by FIRST Project | Views: 965

Torture Survivors must often surmount language, cultural, memory and concentration problems to improve their health in their new home. . .

NOTE: Names and other identifying details have been changed to protect client confidentiality.

Refugees, immigrants, and others with limited English skills are often unfamiliar with the health system in their new home. For instance, they may not have therapy or counseling, or perhaps it is more usual to consult a spiritual leader, elder or traditional healer for the emotional problems that therapists help their patients with. For either or both of these reasons they don't know how to use the health system in their new home and/or they do not trust it. Often when they are first learning about it, they use it inappropriately. For instance, they visit the emergency room instead of the doctor's office.

Some refugees and immigrants may have survived torture or trauma before coming to Lincoln. Some research shows that 5-35% of all refugee populations are torture survivors. However, these numbers are thought to be conservative. According to other studies, in some refugee groups (i.e. the Somali Bantus) as many as 69% are probably torture survivors. Torture and trauma can lead to behavioral health problems and/or can exacerbate other adjustment problems. Torture survivors may suffer from Traumatic Brain Injury, anxiety, depression or Post-Traumatic Stress Disorder. Each of these can make it very difficult to concentrate and remember, so it's harder to learn to new things. Some FIRST Project clients are coping with more than one of these disorders.

FIRST Project is committed to training our torture survivors in how to improve their behavioral health by taking a holistic view of health. For example, Sana is a 38-year old woman from the Middle East and a FIRST Project client. She is married, has eight children, and her husband has a nervous disorder. Soldiers killed her father. Her entire family experienced abuse and torture. Sana's family also had a history of diabetes. In fact, Sana held her sister as she died of the disease. Sana, like many of our torture survivors, has uncontrolled diabetes. For three years when she visited doctors, her young son had to translate for her. Twice she almost died because she did not follow the new medication's instructions that he had translated for her. A hospital dietician gave Sana instructions about how to modify her diet. Sana nodded attentively when receiving these instructions but did not really understand. Her doctors also sent her to training for diabetics at the hospital in an effort to control the diabetes.

Sana understood there was urgency about her illness and its dysregulation. However, since she could not understand what she needed to do, she focused on what she knew: pricking her finger to measure the glucose level. However, as a result, sometimes she pricked her fingers 14 times a day because she was trying to cooperate. Sana has also been diagnosed with Post-Traumatic Stress Disorder (PTSD) and Major Depression. In her anxiety to not die as her sister had, she pricked and recorded all of the information.

Some days she starved to bring her glucose level down because she had not understood the diet instructions. Sana had never heard of food categories like carbohydrates, protein, or fats. Neither did she understand how foods from those different groups affected her diet or her diabetes. Finally, during this past year her FIRST Project case manager, Heba, went with Sana to appointments with her physician and to those with the dietician. Sana's diabetes is stabilized for the first time.

Heba took the physician's information and translated all of it because sometimes numbers had been omitted. Heba made sure Sana understood how the glucose level affected the corresponding amount of insulin she had to take. Heba also made sure Sana knew how the information from the dietician applied to her native foods. She even went to the supermarket with Sana to teach her how to read labels and gain better control of her diet. With the dietician's help, Heba made a list in Arabic of the types of foods in each category (i.e. bread, pasta are examples of carbs). Sana keeps this list on her refrigerator along with another list that Heba and the dietician created?a model meal plan that Sana can follow to keep her diabetes in check. At first, Heba asked Sana to keep a diary of what she ate for a week so that they could see how she was doing on the new plan. Sana still keeps that diary and has started to lose weight.

Finally, Heba worked with Sana on communicating with her physician. The results have been positive for this client who had always wanted to comply with medical treatment but had not understood it well enough to do so. Now her son does not have to worry that his lack of explanation or information to his mother could kill her?a horrible responsibility for a child. Sana's physician feels more effective in caring for his patient. Since Heba and FIRST Project intervened, their patient-physician relationship has had an obvious improvement. Most importantly, Sana is healthier today.

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FIRST Project
1000 "O" Street Suite 102
Lincoln, NE 68508